Making the Shift to a Participatory Approach

Moving from 'Teacher-as-Expert' to 'Teach-as-Facilitator'

What is a typical TWS group like?

Inclusion, caring, mutual respect and shared power are values at the heart of the Teach-With-Stories Method ™.

The 'teacher' or leader functions as a facilitator, not an expert, in an active participatory process.

Everyone is a teacher AND a learner.

Stories and experiential activities involve the whole person.

Multiple ways of knowing are honored and valued.

Who we are and how we grow and learn are understood in relationship with others and our environment.

Credit: Figure (above) adapted from Parker Palmer (2007)

How do you know if you've made the shift?

When we developed the Teach-With-Stories Method ™, we paid close attention to making and sustaining the shift to a participatory teaching approach.

Throughout our cycles of action and reflection, the reported experiences of participants, as well as team and staff member experiences and observations, included many examples of empowerment-based characteristics and participatory group dynamics.

The results we observed were consistent across groups and time, even with different facilitators, sites, and frequency of sessions.

Lessons Learned

If you are going to facilitate a TWS group

How would you describe the felt-sense of the group? Did the group reflect empowerment-based characteristics, such as vitality, mutuality, an enhanced sense of connection and motivation to learn?

How did group members participate, for example, were they actively engaged, did they ask questions?

What dynamics did you experience or observe? Did the dynamics foster critical thinking, relevant content, a deeper understanding of the health messages in the context of one's life, and changes in thoughts, attitudes, and behavior?

1. Group members participated actively in the sessions, with a sense of 'vitality' in the group.

"At first, I felt 'tentativeness' in the air, a shyness or timidity. Once the women got the hang of the photonovel process, members were quick to volunteer to read the parts. The groups had a dynamic energy, with a lot of enthusiasm in the group interaction" (Phase I: Observer field notes)

The 'zestful' energy of the groups is characteristic of motivated participants and the empowerment process at work. Most significantly, these participants were from the same target population as those who were described by health care providers in the study sites as typically difficult to recruit, engage, and/or retain in traditional prenatal education classes.

2. Participants built strong connections with each other.

“The mothers in the class bonded quickly and formed a very supportive and cohesive group. They were soon calling each other outside of class time, and even giving each other rides, and so on.” (Phase II: Group 3 facilitator field notes)

“Here we developed a "comadreria" (friendship among mothers) that helped us through the pregnancy.” (Phase IV: Translation- focus group participant)

"At the Beaufort classes, one mother was paying a taxi $30 per week so she could attend classes. Everyone seemed very eager to learn, and participated actively in the discussion. They also seemed hungry for contact with their peers. Some planned to visit the next series with their babies to help other pregnant women learn from their experiences." (Phase III: Group 5 mentor field notes)

3. Participants expressed a change in their experience and feelings of self-worth.

“Here (in the US), women are worthy. In our country we barely have some rights. Now I know that I am valuable as a woman, mother, and friend.” (Phase IV: Translation- focus group participant)

“The women indicated that the biggest benefits of the program were the renewed sense of worthiness and that they found “support in one another and no longer felt alone.” (Phase IV: Draft focus group report, 3/3/2006)

4. Participants found the sessions relevant to their lives and concerns.

“Here (in the US), women are worthy. In our country we barely have some rights. Now I know that I am valuable as a woman, mother, and friend.” (Phase IV: Translation- focus group participant)

“The women indicated that the biggest benefits of the program were the renewed sense of worthiness and that they found “support in one another and no longer felt alone.” (Phase IV: Draft focus group report, 3/3/2006)

"When discussing the 'Risks During Pregnancy' photonovel, the women initiated and carried out a very honest discussion about the pain of growing up being abused as children and they do not want to repeat this and inflict this suffering on their own children. The discussion also included the connection of domestic violence between parents. They offered one another a lot of validation, support and empathy. I added pertinent information about parenting, the dynamics of domestic violence and encouragement to seek help if the women are in this type of situation now. The group discussed places and people who could provide help." (Phase II: Group 3 facilitator field notes)

“We feel much less anxiety about having our baby. Many of our questions were answered about practical things- like parking, where to go and how to get around in the hospital, and who can attend the birth.” (Phase III: Translation-couple who attended the community session)

5. Participants learned new information and changed some beliefs and behaviors.

“In our countries we place our babies on their bellies when asleep and now I know that is not good. Now I know that babies should sleep on their backs.” (Phase IV: Translation- focus group participant)

"As a maternity care coordinator, I spend a great deal of time discussing childbirth and related topics with prenatal patients. I have noticed a remarkable difference in the women who have attended the classes taught using this model. When discussing birth plans with these women, I have noted a great sense of confidence regarding the information that they have learned. One first-time mom explained the labor process to me as if she were teaching me how it is." (Phase I: MCC Supervisor, 2/19/99, correspondence)

"During a discussion of the photonovel 'Going to the Clinic', one woman reported that she was not going to prenatal visits every month because she didn't think it was necessary. Her previous baby had been healthy without prenatal care. The other women in the group advised her that she should go every month, and that it is very important to go. The facilitator explored with the group some of the reasons why it is important to go to prenatal visits. The next week the woman was late to class because she had followed-through and went to her scheduled prenatal appointment. The other women gave her a round of applause and a lot of verbal approval and affirmation for keeping her appointment." (Phase III: Group 4 mentor field notes)

6. Participants shared what they were learning with others.

"Another great benefit I have noticed is the communication that continues beyond the classroom. As many of the women ride on the prenatal van, they have to wait for a while after the class is over for other women to be seen by the provider. On several occasions, I have heard the women discussing the topics with each other and other pregnant women who did not attend the classes. Not only have the women formed a bond amongst themselves, they are also reaching out to other women indicating their level of confidence with the information." (Phase I: MCC Supervisor, 2/19/99, correspondence)

Observations and self-reports of 'teach-back' examples were common among group members across all four phases.

When people 'teach back' new information in their own words to someone else, it indicates comprehension and that they have assumed 'ownership.' Their interaction with the information enhances and reinforces long-term retention (Doak et al., 1996).

7. Participants often brought or referred other women to the groups.

“Unanimously, these women indicated that they wanted more classes and some of them have already “referred” some friends.” (Phase IV: Project Coordinator field notes.)

The participants' willingness to bring and refer their family and friends in their community is a strong indicator of acceptance and satisfaction with the TWS Method and use of photonovels for prenatal education. Their feedback during the series debriefings and observations of facilitators and observers were consistent with these actions.

The Spirit of "De Madre a Madre"

Teaching with stories, one of the oldest forms of education, is found in cultures around the world. We wanted to harness this oral tradition to transform how we were providing prenatal education for Latinas to provide a community of caring, sharing, learning and growing for themselves, each other, and their families.

“The older women were the arks of instinctual knowing and behavior who could invest the young mothers with the same. Women give this knowing to each other through words, but also by other means.

Complicated messages about what and how to be are sent simply through a look, a touch with the palm of the hand, a murmur, or a special kind of “I cherish you” hug... It is this way among healthy creatures and among healthy humans.

In this way the child-mother is swept across the threshold into the circle of mature mothers, who welcome her with jokes, gifts and stories.”